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Hello. My name is barb farrell. Im.
A pharmacist working in the geriatric day day hospital. Every era. Continuing care in ottawa.
Canada and one of the leads of d. Prescribing guidelines program of research at the briere research institute in my clinical practice. I see many older people taking multiple medications that are sometimes no longer needed or causing more harm.
Than benefit. While medications are started because theyre intended to control symptoms. Prevent or slow.
The progression of a disease. Not all of them are always needed lifelong medical conditions may change as people age and the same medication that worked well before may not be the best one anymore drugs. May also cause more harm with time older people are at more risk for harm because they respond to and handle drugs differently.
They can be more sensitive to side effects and have a harder time eliminating drugs from the body as they acquire more medical conditions they get started on more medications and are at risk for additive side effects and drug interactions sometimes side effects of drugs go unrecognized and new drugs have started to treat the side effects side effects can contribute to many problems we see in older people like falls and confusion when the risks of medication use start to away the benefits would call this problem polypharmacy polypharmacy is especially problematic for older people who are frail this brings us to the concept of deep prescribing. This term was coined in 2003. To help highlight its importance in the overall prescribing approach.
We defined e prescribing as the planned and supervised process of those reduction or stopping of medication. That may be causing harm or no longer be providing benefit in other words reducing medication safely to meet lifes changes. The goal of deep prescribing is to reduce medications.
Ordering and harm. While maintaining or improving quality of life. But reducing doses or stopping medications can be difficult.
Sometimes. The original reason for the medication is unknown especially if it was prescribed many years ago or by a different prescriber or in a hospital. Sometimes prescribers are worried about what might happen if they stop a drug.
Theyre not sure if a drug can be stopped abruptly or needs to have the dose lowered slowly and many disease guidelines. Recommend adding drugs. But they dont address when or how to stop them our research team decided to help address this problem by rigorously developing evidence based guidelines that help clinicians make decisions about when its appropriate to reduce or stop medications and then how to do so safely first we surveyed family physicians geriatricians nurses and pharmacists across canada to find out what drug classes they needed to have guidelines for to help them be prescribed.
We conducted scoping reviews of the literature to find out which of those high priority drug classes had published studies comparing continuing versus. Reducing or stopping them then we formed an interprofessional guideline development. Team for each drug class each guideline development team carefully identified the scope of their guideline.
What medical conditions would be considered or excluded and how would other treatment approaches for the condition be handled each team generated key clinical questions to explore for the guideline. These included considering the impact of deep prescribing. The medication in the targeted conditions.
The harm of continuing. The medications patient or caregiver values and preferences regarding the medication and cost of both continuing or deep prescribing. The medication essentially.
We wanted each guideline to help answer questions about when a medication should be continued reduced or stopped whether it would hurt a person to deep prescribe how to de prescribe safely and effectively and what to monitor while be prescribing members of the teams conducted. Systematic reviews of the literature to rigorously if evaluate the evidence for deep prescribing. The plan was to provide healthcare providers with the evidence for d prescribing so they could consider it in the same way they considered evidence for prescribing each.
Team used the grade approach to make recommendations about d. Prescribing. Grade.
Stands for the grading of recommendations assessment development and evaluation. It considers four factors in determining the strength of a recommendation the quality of supporting evidence certainty that the desirable benefits outweigh the undesirable harms certainty or variability in values and preferences of individuals uncertainty about whether the medication or d prescribing. The medication utilizes a wise use of resources after developing the main recommendations about when its appropriate to d.
Prescribe the medication each team used its clinical experience. As well as information in the d prescribing studies to provide advice about how to safely d prescribe when to reduce the dose slowly and how often or when it was safe to just stop. The drug clinical considerations for each guideline.
Included documenting what factors. Warrant continued use how can patients be engaged in the d. Prescribing process.
How should capering be approached. What should be monitored. And how often and how to manage recurring symptoms next each guideline was reviewed by independent healthcare providers and then by organizations that might consider endorsing the guideline.
All reviewers used a method called agree to which stands for the appraisals guidelines for research and evaluation. This method allowed reviewers to evaluate the process of guideline development and the quality of the report. A full description of our d.
Prescribing. Guidelines methods are published online in the journal plos. One to help health care.
Providers use the recommendations outlined in the d. Prescribing guidelines. Each team developed a two page d.
Prescribing. Algorithm for each of the guidelines. One side of the algorithm.
Illustrates the. D. Prescribing.
Decisions. Recommendations. Monitoring and management plans to carry out the process.
Safely. It also includes the conditions for which d prescribing should not be considered using the guideline on the other side of the algorithm. Weve included information about the dosage availability for each medication and targeted class patient engagement strategies information about the side effects of the drug class and information about non drug management of conditions to help reduce reliance on medications in our research using these algorithms healthcare providers have told us how useful they have been to aid decision making each of the currently available d.
Prescribing algorithms can be found. At d prescribing. Org.
Our future research will focus on how these guidelines and algorithms can be integrated into usual practice. And the impact of using them on patient care. You can check in on the progress of our research.
At d. Prescribing. Org.
And by following us on twitter. In our next series of videos. I will show you how to use each of the d prescribing algorithms for different types of situations to help us continue to improve this and other videos please take a moment to complete this brief survey.
The d prescribing guidelines project was initially funded by the government of ontario through the ontario pharmacy research. Collaboration with recent funding through the canadian institutes of health research. Id like to thank our team of investigators and staff as well as those who contributed to developing and reviewing each of the d.
Prescribing guidelines and algorithms included in this important initiative. You .
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